Does increased access increase equality? Gender and child health investments in India

Abstract

a b s t r a c tIncreases in access to social services are often thought to decrease inequality in the level of these services between advantaged and disadvantaged groups. This is an issue in the developing world, where policymakers often argue that increasing the level of health care, for example, will decrease gender inequality. However, increases in access to services often have empirically ambiguous effects on inequality, increasing it in some cases and decreasing it in others. This paper argues that this is not surprising, and simple economic theory suggests that we should expect a non-monotonic relationship between access and inequality. At low levels of access to investments, there is no investment for either the advantaged or disadvantaged group, producing equality. Increases in access increase investment for the advantaged group first, generating inequality. Further increases in access increase investment in the disadvantaged group, decreasing inequality. I test the predictions of this theory using data on the availability of health camps (or distance to health centers) and gender differences in vaccinations in India. I find strong support for a non-monotonic relationship between access and gender equality.

Empirically probing the quantity–quality model

“…Airola and Juhn 2005;Attanasio and Binelli 2010), or social norms supporting preferences for sons (e.g. Deaton and Subramaniam 1996;Oster 2009;Chakravarty 2010), the gender of a child plays an important role in parents' human capital investment decisions and processes.…”

The Missing Link Between Parents’ Preferences and Daughters’ Survival: The Moderator Effect of Societal Discrimination

“…Regarding the base level of discrimination within the household, we find that each increase in sons' deaths is associated with 0.005 more daughters' deaths (p < 0.001). Moreover, a greater amount of durables is associated with 0.003 fewer daughters' deaths (p<0.001), which supports the idea that household socioeconomic status helps parents to fight against the avoidable mortality of children (Oster, 2009a;Pande, 2003;Shepherd, 2008).…”

“…The ownership of durables is used as a proxy for family socioeconomic status, as it is associated with long-term household wealth. The ownership of durables is associated with the increased health of children (Pande, 2003), and reduced mortality (Shepherd, 2008), although investments in sons' and daughters' health may be unequal (Oster, 2009a).…”

“…The role played by district level characteristics and survey year. The capacity of couples to fight against child mortality is strongly related to access to district facilities, such as health services (Oster, 2009a). In this regard, it is worth mentioning that the National Family Health Survey (round 3) fails to provide district identification.…”

“…An alarming type of discrimination is intrahousehold discrimination against female children (Lin, Liu, & Qian, 2014;Mangyo, 2008;Oster, 2009a;Qian, 2008;Rohlfs, Reed, & Yamada, 2010;Rosenzweig & Schultz, 1982).…”